APPLICATION for INTERBANK GIRO H E
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er e APPLICATION FOR INTERBANK GIRO h e
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s TO CHECK APPLICATION STATUS, SEND
PLEASE TICK: NEW APPLICATION CHANGE OF BANK ACCOUNT PART 1: PARTICULARS OF APPLICANT Date
To: Name of Bank Name of Billing Organisation STARHUB LTD Branch StarHub Customer Name
StarHub Customer Address StarHub Customer NRIC / FIN Number / BRN
StarHub Account Number
StarHub Payment Code This can be found on the top right corner of the Bill
(a) I/We hereby instruct you to process StarHub Ltd’s instruction to debit my/our account. (b) You are entitled to reject StarHub Ltd’s debit instruction if my/our account does not have sufficient funds and charge me/us a fee for this. You may also at your discretion allow the debit even if this results in an overdraft on the account and impose charges accordingly. (c) This authorisation will remain in force until terminated by your written notice sent to my/our address last known to you or upon receipt of my/our written revocation through StarHub Ltd. (d) Amendments made on the form must be countersigned by the bank account holder. (e) This application will supersede existing payment arrangement of this account with StarHub Ltd. (f) I agree to StarHub Ltd collecting, using and disclosing my personal data for the purposes of processing this recurring payment arrangement, payments and refunds. PART 2: PARTICULARS OF BANK ACCOUNT HOLDER
My/Our Name(s) as in Bank Account My/Our Contact Number(s)
My/Our Bank Account Number
PLEASE REMEMBER TO SIGN HERE Company Stamp/Signature(s)/Thumbprints* (As in Financial Institution’s Records) *For thumbprints, please go to your respective bank branches with your identification.
PART 3: TO BE COMPLETED BY BILLING ORGANISATION
Bank Branch StarHub Bank A/C No. StarHub Payment Code
Bank Branch Bank A/C No. To Be Debited
PART 4: TO BE COMPLETED BY BANK
To: StarHub Ltd c/o DBS Bank Ltd Accounts Services, 750E Chai Chee Road #04-01 Technopark@Chai Chee Singapore 469005 This application is hereby REJECTED (please tick) for the following reason(s): Signature/Thumbprint# differs from bank’s records Wrong account number Signature/Thumbprint# incomplete/unclear# Amendments not countersigned by customer
9 # 0
/ Account operated by signature/thumbprint Others: 10 1166 /
Name of Approval Officer Authorised Signature Date
#Please delete where appropriate NOTES ON GIRO
1. Please fill up all the information in Part 1 of the GIRO application. This is to avoid any delay when we process your application form. 2. If you wish to use different GIRO accounts to pay for the different services that are currently billed in one account, please contact our billing hotline at 1637 from 8.00am to 9.00pm, Mondays to Saturdays. For Business customers, please call 1631 from 8.30am to 9.00pm, Mondays to Saturdays (excluding Public Holidays). 3. The approval of GIRO application is subject to the bank’s discretion and will require 4-6 weeks to be processed. 4. An official letter will be sent to you once your GIRO application is approved. 5. When your GIRO arrangement is in effect, you will see a note “The total outstanding balance will be deducted from your bank account xxxxx via GIRO on dd/mm/yy” on your bill. The total account outstanding will be deducted accordingly. 6. Please maintain sufficient funds in your bank account for the GIRO deductions to avoid any administrative or late charges. StarHub is not liable for any surcharges/fees imposed by the bank for unsuccessful deductions from the designated GIRO bank accounts. 7. In the event of unsuccessful deductions, you will need to pay your bills by cash, cheque or credit cards immediately. GIRO arrangement will also be terminated after 2 consecutive unsuccessful deductions. 8. For termination of GIRO payment arrangement, please send us an official letter to the following address or fax to 6721 5051. In your letter, please include your name, StarHub account number, bank account number and your signature. For bank account holders, please refer to the bank for GIRO termination. Kindly note that termination is only in effect when the message in note 5 above is not stated on your bill. StarHub Ltd Finance Department 67 Ubi Avenue 1 #05-01 StarHub Green Singapore 408942 9. A consenting third party may pay for your StarHub bill. Please fill in your name, address, NRIC/FIN number/BRN fold here and StarHub payment code in Part 1 of the GIRO application form. The third party is to fill in his/her name, bank account number, contact number and sign on Part 2 of the GIRO application form. 10. In the event that the StarHub bill is paid by a consenting third party, StarHub shall take written instructions from the StarHub Customer (as stated overleaf) only, in respect of all matters pertaining to the StarHub Account (as stated overleaf), including but not limited to the payment instructions and services subscribed to. 11. For more queries on your GIRO application, please contact our billing hotline at 1637 from 8.00am to 9.00pm, Mondays to Saturdays. For Business customers, please call 1631 from 8.30am to 9.00pm, Mondays to Saturdays (excluding Public Holidays). 12. Please do not staple or tape to seal the GIRO form.
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